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Histological studies demonstrate disorganised collagen fibres and increased matrix metalloproteinase activity within tendons, changes associated with oxidative stress and disrupted extracellular-matrix turnover (83)

In NAFLD or MASLD, the liver undergoes a self-perpetuating cycle of IR and lipotoxicity, leading to the dysregulation of key metabolites involved in energy homeostasis [28]

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Full healing cycles typically require eight to twelve weeks for optimal collagen remodeling and tissue repair

Importantly, patients may intentionally conceal testosterone use due to a lack of trust in medical personnel, further complicating diagnosis and management